Provider Demographics
NPI:1740297449
Name:COLLINS, ROSEANNE KELTON (MD)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:KELTON
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 E CALLE DEL MEDIO
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4442
Mailing Address - Country:US
Mailing Address - Phone:602-616-5339
Mailing Address - Fax:
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7076
Practice Address - Country:US
Practice Address - Phone:602-224-9218
Practice Address - Fax:602-224-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF64833Medicare UPIN
AZ23550Medicare ID - Type Unspecified